DIVERT-CARE Catalyst Study
In Canada, publicly funded home care clients account for 6%, 15%, and 32% of the household population aged 65-74, 75-84, and aged 85 or older, respectively. Specific evidence to support home-based emergency department (ED) prevention is limited, but reviews suggest that effective interventions employ multiple components rather than single isolated interventions. Applying costly preventative efforts to all community clients is not feasible. Therefore, we need to identify clients who are at highest risk of ED use to target preventative care.
Can a targeted, feasible, and evidence-based intervention reduce ED visits among home care clients in the Hamilton Niagara Haldimand Brant Community Care Access Centre (HNHB CCAC)?
This project involved two major phases:
First, we derived and validated the Detection of Indicators and Vulnerabilities of Emergency Room Trips (DIVERT) Scale case finding tool to help identify the likelihood of future ED use among important clinical subgroups of home care clients. We used the DIVERT Scale for the first time in Canada.
Second, care and communication protocols were refined for target groups identified by the DIVERT Scale. The pilot involved extensive profiling of home care clients’ needs followed by the development and implementation of supportive chronic disease management interventions (e.g., medication reconciliation, self-care education, advanced care planning). Communication tools and protocols were developed between home care, primary care, pharmacy, and medical specialists.
The combined use of the DIVERT Scale with a pilot chronic disease management service was the focus of a 2-year pilot project among 3 home care caseloads and included 100 high risk home care clients. Compared to two prospectively matched cohorts (direct matching and indirect adjustment) the ED use was reduced by approximately 20% over the 7-month study period. The pilot was recognized on the 2016 Ontario Minister’s Medal Honourable Role for Excellence in Health Quality and Safety.
The trial is led by a multi-provincial collaboration of home care partners, home care collaborators, researchers, and clinicians.
Andrew P. Costa, PhD | McMaster University
Tom Peirce, MBA | HNHB CCAC
Beth Dube, BScOT | HNHB CCAC
Colleen Lackey, RN, BScN | HNHB CCAC
Dilys Haughton, RN (EC), MHSc | HNHB CCAC
Gail Riihimaki, BHSc OT, MBA | HNHB CCAC
Jane Blums, BA, BScN, MA | HNHB CCAC
Lia Salam, BSc, MSc | HNHB CCAC
Jenn Bucek, MSc | HNHB CCAC
Chaim Bell, PhD, MD, FRCPC | Mount Sinai Hospital
Susan Bronskill, MSc, PhD | Institute for Clinical Evaluative Sciences
George Heckman, MD, M.Sc. | University of Waterloo
Robert McKelvie, MSc, MD, PhD, FRCPC | McMaster University
Lori Mitchell | Winnipeg Regional Health Authority
Samir Sinha, MD, DPhil, FRCPC | Mount Sinai Hospital